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Science of making babies is far from perfect

It’s become a numbers game of age, probabilities and high-priced procedures

Dr. Jeffrey Roberts is a reproductive endocrinologist at the Pacific Centre for Reproductive Medicine in Burnaby. He thinks egg vitrification will eventually extend women’s child-bearing years.

Photograph by: Jason Payne
, VANCOUVER SUN

A whole generation has been born since Canada’s first “test tube baby” saw daylight in Vancouver almost 30 years ago.

And it’s been 20 years since B.C.’s Patricia Baird issued a royal commission report on the murky ethics of creating life in a petri dish.

Now almost 10,000 babies are born in Canada each year through in vitro fertilization, or IVF, as the unheard of has transformed into the unremarkable.

The latest twist is the possibility of preserving human eggs long enough for a woman to outrun her own biological clock. Hence headlines in glossy magazines like, “Now that everyone’s freezing their eggs — should you?” or “Eggs, no sausage.”

Scientific advances once confined to university laboratories are now pioneered in private clinics around the world. The Canadian government has all but bowed out of the sector except for issuing a ban on cloning and the purchase of eggs, sperm and embryos. Women are left to do some high-priced shopping if they want to have children, but find they or their partner are infertile. A limited number of related medical procedures are covered under provincial health care plans with Quebec being the only province to cover IVF.

In the case of egg freezing, the price is about $10,000 for each round of egg retrieval. It requires injecting themselves with various hormones to force multiple eggs to mature in their ovaries. Not to mention rafts of tests and the final harvesting of the eggs, under sedation, with a needle guided by ultrasound through the vagina to the ovaries. Somewhere between eight and 15 eggs are typically harvested per ovulation cycle and some women go through several rounds to get the optimal number of eggs needed to give them a decent chance of having a child.

Will the latest technology in freezing human eggs — called vitrification — now release women from their body’s limitations? It allows a younger woman to freeze 10 or 20 eggs when she is single and then use them to produce her own biological child when she finds “Mr. Right” — up to age 50 at some clinics.

“I see a lot more younger women now asking for it. The younger you freeze the eggs, the higher the potential for them to work. Freezing eggs when you’re 40 unfortunately has a very limited prognosis,” she says.

“It’s not a guarantee. People like to think of it as more of an insurance policy. You don’t want to freeze them, forget about it and think they’re automatically going to work when it comes to use them.”

That’s because by age 35, there’s about a 30 per cent chance that the implantation of a fertilized egg will result in a live birth.Still, the scenario started to look a bit more believable late last year when the American Society for Reproductive Medicine — an organization that sets guidelines for the sector — removed its “experimental” label from the procedure. A committee of doctors found that the limited research available showed similar rates of live birth from freshly harvested eggs and ones preserved using vitrification, a process that freezes the eggs more quickly than previous methods.

(Human eggs are difficult to freeze and thaw successfully because of their high fluid content. Laboratories have better success freezing and thawing recently fertilized embryos, but ethical considerations about the beginning of life make that option less desirable for many.)

The ASRM committee also concluded that the success rate was much lower for women 38 or older and recommended the procedure not be marketed to them as a method of prolonging their child-bearing years. That’s because females are born with all their potential eggs already in their ovaries. They age along with the rest of the body, making egg quality the single biggest limiting factor for female reproduction. Sperm from older men may be of a lower quality, but the short-lived swimmers are produced throughout a man’s life.

An estimated 2,000 babies have been born, worldwide, using vitrified eggs. It’s not known how many are from elective egg preservation, because egg-freezing techniques have mainly been used to help young women scheduled to undergo cancer treatment.

Dr. Jeff Roberts of the Pacific Centre for Reproductive Medicine based in Burnaby says he thinks egg vitrification will eventually extend women’s child-bearing years. His clinic is already storing eggs for 10 patients using the slow-freeze method, but will start vitrifying eggs this month.

“It seems to be a safe technology with a high rate of success. I think a lot of these age cutoffs are going to shift,” said Roberts.

“It’s a technology we generally recommend for women under 40. The older the woman is, the less likely it’s going to work whether it’s fresh or frozen. In women over age 40 who see us, the live-birth rate using our best technology — which is in vitro fertilization — is going to run around 27 to 29 per cent. If vitrification provides for eggs that are almost the same quality as fresh, it may be a viable option for women up to our cutoff for IVF which is 45.”It’s worth noting that while private clinics often post high success rates, national figures compiled by the Canadian Fertility and Andrology Society say 11 per cent of women over 40 had a live birth after IVF treatment in 2008 and only seven per cent were healthy singleton babies, due to the common practice of implanting two or three embryos at a time in that age group to increase the chances of success.

Fertility clinics consider 30 to 40 per cent to be reasonable chances so patients have to gauge their own tolerance for costly gambling.

For Jennifer Krueger of Aldergrove, that’s meant about $20,000 in two unsuccessful IVF treatments — using her own fresh eggs and her husband’s sperm — only to find out later that they were poor candidates for the procedure because a chromosomal defect makes his sperm unlikely to produce a viable embryo.

“They didn’t tell me that until I had spent 20 grand,” said Krueger, who turns 37 at the end of this month.

She says reproductive technology in general leaves it up to consumers to do an incredible amount of complex medical research every step of the way to ensure they’re getting suitable treatment. In her case, a blocked Fallopian tube should have been opened — a procedure covered by public health care — before her initial round of IVF. Then a $1,500-genetic test, also covered by health care if it’s recommended by a specialist, could have shown it was futile to try a second time.

“It seems the doctors don’t push the stuff that’s covered as much as the stuff that’s not.”

In addition to the financial cost, Krueger says the process puts couples through the wringer. Huge doses of hormones before egg harvesting can make women emotionally overwrought, then there are the high hopes, weeks of waiting, followed by disappointment and grieving.

“In my graduation yearbook, for the question, ‘Where do you want to be in 10 years?’ I said I wanted to be a mum.

“I think it will always bother me. I don’t go to baby showers anymore. I don’t talk to pregnant people. I don’t think I will be at peace with it.”Dr. Anthony Cheung of Grace Fertility Centre in Vancouver says ruling out easily fixed causes of infertility should be the first step. Smoking, alcohol, drugs including marijuana and testosterone supplements used by bodybuilding men, stress, being overweight or underweight, and simple bad timing can all be contributing factors. He has a naturopathic doctor on staff to talk to patients about those issues before they move to more invasive methods.

A larger problem, he says, is that women are pushed to succeed in education and careers during the same years when they are best able to have children, their 20s and early 30s.

“Where’s the freedom for the woman?” asks Cheung. “That’s a bigger issue.”

He suggests a revised tax structure that helps young Canadians start families.

Dr. Beth Taylor is part of a group of doctors previously with the Genesis clinic who are set to open the Olive Fertility Centre on Cambie Street in June where they plan to offer egg vitrification.

“I think the message is that women should not wait until their late 30s or early 40s before starting to think about their fertility. What’s happening now is people are aware that fertility is lower in their 40s and at that time they pursue egg freezing, but people should be aware that their fertility is declining earlier than that and the success of the fertility treatment is age-related. So the sooner the better.”

A free public talk called Understanding Your Fertility options will be held at 7 p.m. on Thursday, May 23, at the Renfrew Public Library, 2969 E. 22 Ave. in Vancouver. Its sponsor, the Infertility Awareness Association of Canada, asks attendees to RSVP because space is limited. Call 604-626-4225 or write iaacwest@iaac.ca

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